Economic issues of medical care for hyperparathyroidism. Part 1. Primary hyperparathyroidism

Economic issues of medical care for hyperparathyroidism are an important scientific area related to assessment of effectiveness and cost-effectiveness of various treatment approaches. The first part of this review is devoted to economic aspects of primary hyperparathyroidism as a common endocrine malignant disease associated with multiple disabling complications (primarily in skeletal system and kidneys). Cost-effectiveness of surgical treatment, various methods of preoperative and intraoperative navigation, and choice of parathyroidectomy methods are discussed. Considering available data, we can argue that screening for calcemia in high risk persons has clinical and economic effectiveness, but large-scale studies have not yet been conducted. Surgical intervention seems to be the most cost-effective option. Most studies devoted to preoperative topical diagnostic methods were performed at the early stages of introduction of various techniques that limited their diagnostic value. Nevertheless, less traumatic selective interventions showed favorable clinical and economic results due to preoperative diagnostics. Under high cost of work in operating theatre, intraoperative analysis of mineral metabolism can lead to unreasonably higher cost of intervention, while some less time-consuming procedures demonstrate comparable results. Economic component of postoperative care of such patients remains virtually unstudied with exception of one study (2011) devoted to telemedicine consultations for such patients. Unfortunately, there is few literature data on this issue, and re-evaluation of previous conclusions is not carried out. This significantly complicates increase of efficiency of medical care for primary hyperparathyroidism. There have been no such studies in our country that does not allow extrapolating world data to the realities of the Russian healthcare system.